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INTRODUCTION DIFFERENT TYPES OF NON CARIOUS LESIONS CONSEQUENCES OF TOOTH WEAR TREATMENT MODALITIES OF TOOTH SURFACE LOSS CONCLUSION REFERENCES
Traditionally, the terms erosion, abrasion and attrition were used to describe non carious pathologic loss of tooth structure.
tooth
wear .
Tooth wear is defined as the surface loss of dental hard tissues other them by caries or trauma .
Tooth wear is a cumulative lifetime process which is irreversible . Clinically tooth wear appears to progress very slowly over years
Tooth wear has the multi-factorial aetiology, but certain clinical features may suggest a major contributory factor.
Traditionally, cervical lesions caused purely by abrasion have sharply defined margins and a smooth, hard surface. The lesion may become more rounded and shallow if there is an element of erosion present
Flattening of cusps or incisal edges and localized facets on occlusal or palatal surfaces would indicate a primarily attritional aetiology. Once dentine is exposed, the clinical appearance is determined by the relative contribution of the etiological factors. If wear is primarily attritional, then dentine tends to wear at the same rate as the surrounding enamel. Erosive lesions cause cupping to form in the dentin.
Exposure of pulp
Pulpitis and loss of vitality
In-vitro measurement
Macroscopic changes Polarized light microscopy Surface profilometry Microhardness tests Scanning electron microscopy In-vivo Microradiography measurement Digital image analysis Iodine permeability Macroscopic Synthetic hydroxyapattite changes powders/discs Replica Calcium and phosphorus technique dissolution Intra-oral carcinogenicity test
Newer methods
Scanning tunneling microscope Atomic force microscope Finite element analysis
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Attrition Erosion Abrasion Abfraction Localized non hereditory Enamel hypoplasia Localized non hereditory enamel hypocalcification Localized non hereditory dentin hypoplasia Localized non hereditory dentin hypocalcification Discolourations Malformations Amelogenesis imperfecta Dentinogenesis imperfecta Trauma
ATTRITION
Derived from Latin word ATTRITIM meaning action of rubbing against something
The physiologic wearing of the teeth resulting from tooth to tooth contact as in mastication.
Shafer
Wear caused by endogenous material such as microfine particles of enamel prisms caught between two opposing tooth surfaces.
Every (1972)
Loss by wear of surface of tooth or restoration caused by tooth to tooth contact during mastication or parafunction
Milosevic, 1998
Attrition occurs at an ultra structural level It can be caused by direct contact between surfaces or the action of an intervening slurry
Distribution of attrition is influenced by the type of occlusion, the geometry of stomatognathic system and grinding pattern of the individual.
If occlusal wear occurs at a rate faster than compensatory physiologic mechanisms, it is considered pathologic.
Vertical loss of enamel of 50-68 m/year is considered physiologic
ATTRITION
PROXIMAL SURFACE ATTRITION (PROXIMAL SURFACE FACETING) OCCLUDING SURFACE ATTRITION (OCCLUSAL WEAR)
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Shiny wear facets with well defined borders The surface of wear facet is flat and flush with the opposing tooth on contact Enamel and dentin wear at the same rate Possible fracture of cusps or restorations Pure attrition shows equal wear on both arches. (unlike erosion)
SCORE
0 1 2
CLINICAL FEATURE
NO WEAR MINIMAL WEAR NOTICIBLE FLATTENING PARALLEL TO OCCLUDING PLANES
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4
EROSION
Derived from Latin verb EROSUM meaning to corrode
Erosion is defined as superficial loss of hard tissue due to chemical process not involving bacteria.
Every (1972)
Erosion is process of gradual destruction of tooth surface, usually by a chemical or electrolytic process.
Imfeld T (1996)
Martin
Dental erosion is defined as the progressive, irreversible loss of hard dental tissues due to a chemical process not involving bacteria
Gandara BK, Truelove EL. Diagnosis and management of dental erosion. J. of Contemporary Dental Practice 1999; 1(1): 1-17
Clinically, erosion is primarily a surface phenomenon The solubility of enamel is pH dependent The rate at which apatite precipitates depends on factors such as calcium binding in saliva. The critical pH of enamel is 5.5, any solution with a lower pH may cause erosion if the attack is lengthy and intermittent over time.
In early stages, erosion effects enamel resulting in smooth, glazed surfaces In advanced cases, restorations may project above the occlusal surfaces and exhibiting concavities known as cupping; increased incisal translucency Rapid process may lead to sensitive teeth due to dentin exposure while slower progressive lesions may be asymptomatic
Extrinsic (exogenous)
Anorexia and bulimia nervosa Chronic alcoholism Morning sickness associated with pregnancy
Clinical severity
SUPERFICIAL EROSION
Activity of progression
Mannerberg described 2 types of erosive lesions as viewed under SEM Active lesions shows distinctive etched enamel prisms resembling honeycomb Inactive or latent lesions faint with unrecognizable characteristics
Enamel erosion appears smooth and rounded and the surface contour is lost Broad concavities within smooth surface enamel Cupping of occlusal surfaces,
Medical History
Excessive vomiting, rumination Gastroesophageal reflux disease (Symptoms of reflux) Frequent use of antacids Alcoholism History of bruxism (grinding or clenching) Morning masticatory muscle fatigue or pain? Use of occlusal guard Acidic food and beverage frequency Method of ingestion (swish, swallow?)
Dental History
Dietary History
Occupational/Recreational History
Regular swimmer? Wine-tasting? Environmental work hazards? Sports energy drinks Tooth brushing method and frequency Type of dentifrice (abrasive?) Use of mouthrinses Use of topical fluorides
Identification of the etiology Preventive measures Patients compliance. Early recognition of erosion is important to successfully manage and prevent disease progression.
Enhance the defense mechanisms of the body (increase salivary flow and pellicle formation).
Saliva buffering capacity resists acid attacks. Saliva is also supersaturated with calcium and phosphorus, which inhibits demineralization of tooth structure
Daily topical fluoride at home. Apply fluoride in the office 2-4 times a year.
Consider application of composites and direct bonding where appropriate to protect exposed dentin. Construction of an occlusal guard is recommended if a Bruxism habit is present.
ABRASSION
Derived from Latin verb ABRASUM meaning Scrape off
Every (1972)
substance
Milosevic, 1998
the cause
Most common area is cervical area, related to improper tooth brushing technique, zealous and vigorous methods, and use of abrasive dentrifice.
pin biting
Proximal tooth abrasion due to improper flossing and use of tooth picks
An abrasion area is generally not well defined unlike in attrition. Abrasion tends to round off or blunt tooth cusps or cutting edges. Where dentin is exposed, it may be scooped out because it is softer than enamel.
PIPE SMOKERS
Microscopically an abraded